L11. Clinical pharmacology and prescribing

Question 1

What are the 4 aims for rational prescribers

Answer 1

Maximise clinical effectiveness, minimise harms, avoid wasting scarce healthcare resources, respect patient choice.

Question 2

What are the steps to making a prescription

Answer 2

1. Make a diagnosis, amend it as treatment continues.
2. Consider treatment options:
   - identify patients goals- symptom modification, disease modification.
3. Choose a medicine:
   - Efficacy: consider who was trialed
   - Safety,
   - Appropriateness,
   - Adherence
4. What is the dose- population vs individually determined and route of delivery
5. Prescribe

Question 3

What are the appropriateness factors when choosing a medicine

Answer 3

• Fitting the condition they still have
• Cost effectiveness for the patient
• Patient choice/adherence: conflict w health beliefs, dosing factors, blood test, gut absorption etc
• Are there other non pharmacological options

Question 4

What are the safety considerations when choosing a medicine

Answer 4

• Drug interactions with disease, medicine, foods,
• Pregnancy/lactation safety
• Contraindications for this drug in general/specific to patient: allergies
• Common adverse effects or severe side effects that can endanger the patient

Question 5

What are the 5 main routes of drug delivery and time released, and other features

Answer 5

• Oral tablets: slow to rise in peak conc, less complete absorption, may 1st pass metabolism
• Skin patches/gels: lower peak conc, extended duration of effect, bypass 1st pass metab, skin reaction: adverse effect.
• Local delivery: targeted site of action, reduce systemic effect
• Depot preparation: deep injection, release contents slowly over hours-months. may improve adherence
• IV: high conc in blood rapid, instant complete absorb, more risky

Question 6

What is the certain information essential for legal prescription

Answer 6

0. Doctors Name and initials, Signature, Physical address, MCNZ registration number, contact phone number,
   - Patient’s name, full residential address and age if under 13 years.
1. Recipe x: Name of medicine, formulation (delivery method) and strength of medicine
2. Patient instructions (Sig):
3. M: instructions for pharmacist specifying quantity of supply

Question 7

What is the maximum period of supply of medicines and exception

Answer 7

3 months except for oral contraceptive which is 6 months supply

Question 8

What are the steps after you prescribe

Answer 8

1. Communicate w patient: explain what and why prescribed, how to take it, benefits and adverse effects and how to manage those. Can give info to take away, adherence tools like blister pack
2. Monitor response: how often when high risk, beginning of therapy. Adverse effects?
3. Follow up and review: The efficacy, safety, appropriateness, align with patient goals.